The proposed Dartmouth Multidisciplinary Clinical Research Center (MCRC) in Musculoskeletal Diseases seeks to promote rigorous clinical research through a focused collaboration of diverse disciplines with an overall objective of improving the health of patients suffering from musculoskeletal diseases. Dartmouth has long had an active clinical research program, primarily associated with two well-established interdepartmental centers in outcomes research and cancer which feature internationally recognized programs in medical care epidemiology and cancer chemoprevention. As Dartmouth's research base has grown, new opportunities have arisen to extend our expertise to NIAMS-related disease areas with a particular emphasis on musculoskeletal diseases. The infrastructure in biostatistics and outcomes evaluation developed for our existing clinical research programs, combined with the initiation of a major NIAMS-sponsored multi-center clinical trial for patient outcomes in surgery for low back pain, provides a unique opportunity to create a new MCRC at Dartmouth. The proposed Dartmouth MCRC will provide methodological and administrative support for achieving the research objectives summarized as follows: Project 1: To assess the prognostic value of lumbar spine MRI for the purpose of improving treatment recommendations and health outcomes of patients with chronic low back pain by assessing the role of magnetic resonance imaging (MRI) of the lumbar spine as an indicator of prognosis; Project 2: To better understand the roles of geography, race, and socioeconomic factors in determining musculoskeletal disease treatment and outcomes; Project 3: To study disability and health-related quality of life outcomes among working patients being treated for a disc herniation; Project 4 (a developmental project): To characterize orthopaedic surgeons' opinions on the principles and practice of using patient decision aids for elective musculoskeletal surgery. We also seek to enhance educational opportunities for clinicians and researchers in training, thereby fostering new clinical research initiatives that will ultimately improve the health of patients with musculoskeletal disease.